Provider Demographics
NPI:1831482090
Name:BLUBAUGH, SALLY JEAN (RN)
Entity Type:Individual
Prefix:MS
First Name:SALLY
Middle Name:JEAN
Last Name:BLUBAUGH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 EDWARDS RD
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:43031-1060
Mailing Address - Country:US
Mailing Address - Phone:740-967-6071
Mailing Address - Fax:
Practice Address - Street 1:206 EDWARDS RD
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:OH
Practice Address - Zip Code:43031-1060
Practice Address - Country:US
Practice Address - Phone:740-967-6071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-20
Last Update Date:2011-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH315601163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse